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<meta name="description" content="读书笔记，感谢作者。牙周组织和牙周病的影像学对牙周组织的总体评估依赖于临床检查和影像学检查。然而，影像学检查仅提供了病程的回顾性的证据。但是，它们可以用来评估受影响患牙的形态，以及牙槽骨丧失的类型和程度。骨丧失（Bone loss）可以被定义为考虑了年龄因素后，对任何患者的目前牙槽骨高度与正常牙槽骨高度的差别。(Bone loss can be defined as the difference">
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<meta property="og:description" content="读书笔记，感谢作者。牙周组织和牙周病的影像学对牙周组织的总体评估依赖于临床检查和影像学检查。然而，影像学检查仅提供了病程的回顾性的证据。但是，它们可以用来评估受影响患牙的形态，以及牙槽骨丧失的类型和程度。骨丧失（Bone loss）可以被定义为考虑了年龄因素后，对任何患者的目前牙槽骨高度与正常牙槽骨高度的差别。(Bone loss can be defined as the difference">
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          <h1 class="post-title" itemprop="name headline">口腔影像学——图像的解释3：牙周病</h1>
        

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        <p>读书笔记，感谢作者。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0023-kqyxx-txjs-yzb/01.jpg"><br>牙周组织和牙周病的影像学<br>对牙周组织的总体评估依赖于临床检查和影像学检查。然而，影像学检查仅提供了病程的回顾性的证据。但是，它们可以用来评估受影响患牙的形态，以及牙槽骨丧失的类型和程度。<br>骨丧失（Bone loss）可以被定义为考虑了年龄因素后，对任何患者的目前牙槽骨高度与正常牙槽骨高度的差别。(Bone loss can be defined as the difference between the present septal bone height and the assumed normal bone height for any particular patient, taking age into account)<br>在牙周病诊治中影像学主要用于：①骨丧失的范围以及涉及到的根分叉；②确定任何导致牙周病发生的局部致病因素；③评估牙根形态和长度；④辅助制订治疗计划；⑤评估治疗方法，尤其是在GTR术后。<br>摄片的时候注意：①解释牙周组织的影像学检查结果，良好的图像质量是必须的——比起牙体疾病来说更加重要，因为对牙周病的图片解释是需要细节信息的。②在用胶片技术时应该降低曝光度，避免对牙槽骨曝光过度。<br>正常牙周组织的影像学特征<br>牙周组织是否健康不能光看影像学检查，临床检查也是需要的。<br>唯一可靠的影像学特征是牙槽嵴顶与釉牙骨质界(CEJ）的关系。如果它们之间的距离在正常限度（2-3mm）以内并且临床检查没有附着丧失的证据，就可以说患者没有牙周炎。<br>健康牙周组织的影像学特征：①后牙区域有薄的，光滑的，平坦的牙槽骨边缘；②在前牙区有薄的，平坦的，点状的牙槽骨边缘。③牙槽嵴顶并不总是很明显的，在前牙区在牙齿之间只有少量的骨质；④牙槽骨与邻牙硬骨板之间是连续的，在接合区域形成一个锐利的角。⑤在近远中牙周膜间隙之间为薄的，平坦的牙槽骨。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0023-kqyxx-txjs-yzb/02.jpg"><br>注意，并不是所有人都有这些影像学特征，缺少它们也并不一定意味着有牙周病的存在。常见的错误：技术错误、过度曝光、牙槽骨的形状和密度的解剖变异。在完成牙周治疗以后，临床症状消失，但影像上仍有可能显示有早期骨质丧失的迹象。因此在影像上观察到骨丧失并不是存在牙周炎症的一个标准。<br>一些术语：<br>水平骨丧失(Horizontal bone loss），垂直骨丧失（Vertical bone loss），根分叉病变(Furcation involvements）。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0023-kqyxx-txjs-yzb/03.jpg"><br>A:轻度牙槽骨丧失，牙周膜间隙增宽，牙槽骨与硬骨板(lamina dura）之间的正常锐角消失；B:中度水平骨丧失；C:广泛的骨水平丧失，伴根分叉病变；D:局限性的骨垂直丧失；E:广泛的骨丧失并涉及到根尖，也叫牙周牙髓联合病变。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0023-kqyxx-txjs-yzb/04.jpg"><br>A:非常早期的根分叉病变，根分叉区牙周膜间隙增宽；B:中度根分叉病变；C:重度根分叉病变。<br>牙周炎的影像学特征：牙槽骨丧失是最主要的慢性牙周炎的影像学证据，包括：①牙槽嵴边缘的骨皮质丧失，骨的边缘变得不对称，锋利；②牙槽嵴区域牙周膜间隙增宽；③皮质骨与硬质骨之间的正常角度丧失——骨的角度变得圆钝和不对称；④局限或广泛性的牙周支持骨丧失；⑤骨丧失的类型——水平或垂直——导致了复杂的骨内缺损；⑥多根牙的根分叉区域的骨丧失——可以从根分叉区牙周膜间隙增宽到大范围区域骨缺损；⑦牙齿之间的牙周膜间隙增宽。⑧与牙周炎相关的局部因素：牙石沉积、龋洞、牙根再吸收、充填体悬突、充填体边缘粗糙、邻接点被破坏、修复体邻接设计不良（包括桥体设计）、侧穿、牙周牙髓联合病变的牙髓状况、对颌牙伸长、倾斜患牙、牙根粗糙(root approximation)、粘膜支持式可摘局部义齿、进展中的楔缺(developmental grooves)、Dens-in-dente（不知道咋翻）。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0023-kqyxx-txjs-yzb/05.jpg"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0023-kqyxx-txjs-yzb/06.jpg"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0023-kqyxx-txjs-yzb/07.jpg"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0023-kqyxx-txjs-yzb/08.jpg"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0023-kqyxx-txjs-yzb/09.jpg"><br>侵袭性牙周炎的影像学表现：①影响第一磨牙和/或切牙的严重的垂直行骨缺损；②拱形或蝶形(Arch or saucer-shaped)骨缺损；③有时骨缺损范围更加广泛；④切牙移位产生间隙；⑤骨丧失速度较快。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0023-kqyxx-txjs-yzb/10.jpg"><br>牙周脓肿(Abscesses of the periodontium）<br>影像学上与其它牙周病的骨破坏无法区分。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0023-kqyxx-txjs-yzb/11.jpg"><br>治疗措施评估<br>要有术前术后的影像，要对治疗技术和暴露因素(exposure factors）进行比较。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0023-kqyxx-txjs-yzb/12.jpg"><br>放射诊断的局限性：<br>①影像重叠和二维图像带来的问题：a.很难区分颊侧和舌侧牙槽骨水平；b.只有一部分完全骨丧失才能看出来；c.一壁的骨缺损会使其它的缺损模糊；d.高密度的牙体或充填体的影像会使颊舌侧骨缺损以及牙石沉积模糊；e.根分叉区域的牙槽骨再吸收也许会被覆盖其的牙根或骨的影像所模糊。<br>②仅提供硬组织的影像信息，软组织通常看不到。<br>③很早期的没有骨密度降低的病变无法检查出来。<br>④摄片技术和接收器类型等因素会影响牙周组织的影像学表现，作为前后对比，这些因素必须一致。<br>⑤曝光因素会对牙槽骨高度的判断有很大的影响。<br>⑥不能依靠全景片进行完整的可信赖的诊断。<br>⑦一些二维图形存在的问题可以通过拍CBCT来解决。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0023-kqyxx-txjs-yzb/13.jpg"></p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的知乎文章地址： <a target="_blank" rel="noopener" href="https://www.zhihu.com/people/zhao-you-min/posts">https://www.zhihu.com/people/zhao-you-min/posts</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/other/wx.jpg"></p>

      
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